American Journal of www.biomedgrid.com Biomedical Science & Research ISSN: 2642-1747 --------------------------------------------------------------------------------------------------------------------------------- Research Article Copy Right@ Lei Li The Impact of Hepatitis Virus Infection on Acute Pancreatitis: A Population-Based Study the Impact of Acute Pancreatitis in Patients with Known Hepatitis Virus Infection Lei Li* Department of Gastroenterology and Hepatology, Zhongshan Hospital, Fudan University, China *Corresponding author: Lei Li, Department of Gastroenterology, Zhongshan Hospital, Fudan University, China To Cite This Article: Lei Li. The Impact of Hepatitis Virus Infection on Acute Pancreatitis: A Population-Based Study the Impact of Acute Pancreatitis in Patients with Known Hepatitis Virus Infection. Am J Biomed Sci & Res. 2021 - 13(4). AJBSR.MS.ID.001897. DOI: 10.34297/AJBSR.2021.13.001897. Received: July 06, 2021; Published: July 22, 2021 Abstract Background and study Aim: We investigated associations between hepatitis virus infection and outcomes of Acute Pancreatitis (AP), and the impact of hepatitis virus subtypes and effects of liver transplantation on AP outcomes in hepatitis virus-infected AP patients. Patients and methods: In this cross-sectional study, data of 163,140 AP patients (5,599 with viral hepatitis; 157,541 without) were extracted from the 2005-2014 Nationwide Inpatient Sample database and analyzed retrospectively using logistic regression. Primary outcomes were in- hospital mortality, leaving Against Medical Advice (AMA), and other diagnoses (i.e., colonic necrosis, splenic vein/portal vein thrombosis, and organ failure). Secondary outcome was hospital length of stay. Results: AP patients with hepatitis virus infection had increased odds of death or AMA (aOR=1.39, 95% CI=1.23-1.57, p<0.001) and organ failure (OR=1.19, 95% CI=1.07-1.33, p<0.001). A significant correlation was shown between death or AMA and liver transplantation. Illness severity was significantly different between hepatitis virus subtypes (p<0.001); the majority of HAV and HBV patients had major loss of function (42.44% and 48.44%,Conclusions: respectively AP patients and 48.87% with hepatitis of HCV virus patients infection had moderate have greater loss oddsof function. of death or AMA and organ failure than those without viral hepatitis, virus-infectedand liver transplantation patients. increases odds for death and AMA but not for organ failure. HCV occurs more frequently in AP patients but illness is more severe with HAV and HVB. The results of the present study may help develop strategies targeting anti-viral agents to ameliorate AP in hepatitis Keywords: Leptospira; Mycoplasma; Hypertriglyceridemia Acute Pancreatitis; Hepatitis Virus; Infection; Outcomes; National Inpatient Sample (NIS); HCV; Organ Failure; Anti-Viral Agents; Introduction causes of AP, followed by hypertriglyceridemia [2], certain drugs (e.g., azathioprine, valproic acid, ACE-inhibitors) [3], infections, characterized clinically by acute abdominal pain and elevated Acute Pancreatitis (AP) is inflammation of the pancreas, trauma and gene mutations and polymorphisms [2,4]. In about levels of pancreatic enzymes in the blood. Incidence is about 36.4 in 10% of AP cases, miscellaneous causes are responsible, including 100,000 population annually, with women affected more than men infection by parasites (e.g., Ascaris lumbricoides), bacteria (e.g., (7.9% vs. 5.7%, respectively); incidence of AP is increasing in the Leptospira, Mycoplasma), and viruses (e.g., mumps-virus, herpes US and Europe, making it the leading cause of hospitalization due simplex, varicella-zoster, coxsackievirus and hepatitis viruses) [5], to gastrointestinal disorders [1]. Gallstones (40%-70%) and excess with each organism causing AP through different mechanisms [4]. or prolonged alcohol consumption (30%) are the most frequent However, to date, studies on the viral causes of AP are limited. This work is licensed under Creative Commons Attribution 4.0 License AJBSR.MS.ID.001897. 461 Am J Biomed Sci & Res Copy@ Lei Li More than half of hepatitis cases in the United States are caused administration if AP resulted from pegylated interferon-alpha 2a RBV for chronic hepatitis C; thus, it is necessary to stop medical by the presence of a specific hepatitis virus. The most common causes are Hepatitis A Virus (HAV), Hepatitis B Virus (HBV) and (PEG-IFN-α-2a) and Ribavirin (RBV) was suspected [13]. Ando et with symptoms such as nausea, abdominal pain, fatigue, and is a potential cause of drug-induced AP in patients with Chronic Hepatitis C Virus (HCV), any of which may result in acute disease al. demonstrated that PEG-IFN α and RBV combination therapy [6]. Acute infection may lead to chronic infection and sequelae, associations between hepatitis virus infection and outcomes of jaundice, leading to significant morbidity and mortality worldwide Hepatitis C (CHC) [14]. Therefore, this study aimed to investigate sometimes progressing to cirrhosis and Hepatocellular Carcinoma AP, and to explore the frequency and outcomes of AP associated with various hepatitis subtypes as well as the effects of liver have been found to cause hepatitis sporadically, primarily in transplantation on the outcomes of AP patients with hepatitis virus (HCC) [6,7]. Hepatitis D Virus (HDV) and Hepatitis E Virus (HEV) infection. report of the Centers for Disease Control and Prevention (CDC) countries where the viruses are endemic [7]. The surveillance Patients and Methods Data source reported incidence of HAV (0.4 per 100,000 population), HBV (1.1 in 2015, but the absence of symptoms in many cases precludes per 100,000 population) and HCV (0.8 per 100,000 population) Data for this study were extracted from the 2005-2014 accurate incidence [8]. Nationwide Inpatient Sample (NIS), a database developed by While hepatitis viruses infect mainly hepatocytes, tissues of other organs such as the pancreas have also been found to carry States that is maintained by the Agency for Healthcare Research the Healthcare Cost and Utilization Project (HCUP) in the United antigens for hepatitis viruses A, B, C, and non-A/non-B viruses [9]. AP is associated with fulminant hepatic failure and hepatitis virus sample of inpatient admissions from 45states and 1051 hospitals and Quality (AHRQ) [12,15]. The NIS database represents a 20% antigens have been found in results of histological and serological that participated in collecting patient data at discharge. Principal examination of pancreatic tissue at autopsy [10]. A study of the and secondary diagnoses, principal and secondary procedures, frequency and characteristics of pancreatitis in acute viral hepatitis admission date and diagnosis, discharge status, patient demographic found that AP occurs in 5.65% of non-fulminant acute hepatitis- data, and length of stay are included for each inpatient. Statistical infected patients and that it is usually mild and both diseases can weights that allow generalized estimates of national case volumes be managed conservatively; among 124 patients, AP was associated are also provided in the NIS. Study design and ethical considerations. A cross-sectional, [11]. Given the known associations between viral hepatitis and AP, with HAV in two patients, HBV in one patient and HEV in 4 patients population-based retrospective study was conducted to analyze we hypothesized that hepatitis virus infection may have an impact inpatient data collected at patient discharge by the HCUP-NIS on AP outcomes, and that different hepatitis virus subtypes and administrative database for ten years from 2005 to 2014. The liver transplantation may influence AP outcomes to some degree. certificate number HCUP-6FVS78J20 was obtained from HCUP-NIS. add insight into AP outcomes and help to develop strategies to treat HCUP [12,15]. Because the NIS originally received signed informed Ultimately, such findings relative to hepatitis virus subtypes may The study conforms to the data-use agreement for the NIS from consent from all included patients to participate in data collection to investigate associations between hepatitis virus infection and hepatitis virus-infected AP patients. Therefore, this study aimed for later evaluation, and patient data in the NIS database were outcomes of AP, and to explore the frequency and outcomes of AP associated with various hepatitis subtypes as well as the effects of the present study. liver transplantation on the outcomes of AP patients with hepatitis subsequently deidentified, signed informed consent was waived for virus infection. Study population AP related to fulminant viral hepatitis has been known, and Among 549,736 eligible patients from the 2005-2014 NIS the association of AP with non-fulminant viral hepatitis is rare. database with the diagnosis of acute pancreatitis (AP) (ICD-9-CM 577.0), data of 163,400 patients with AP were included. Patients The mortality of AP relies on the severity of hepatitis rather than to the effects of hepatitis were excluded, including those with gall pancreatitis. Usually, these cases are attributed to HAV, HBV, HCV or with other significant causes of AP that could act as confounders be induced during the therapeutic process. Choi et al. reported that stones (ICD-9-CM 560.31), alcohol abuse (ALCOHOL/Severity), and HEV [12]. In patients with known hepatitis virus infection, AP may lipid metabolism disorders (ICD-9-CM272). AP may occur during the combination therapy of PEG-IFN-α-2a and American Journal of Biomedical Science